Risk Factors For Relapse Research Articles

Factors associated with early relapse of infantile haemangioma in children treated for at least six months with oral propranolol: A case-control study using the 2014–2021 French Ouest DataHub

BackgroundThe factors associated with early relapse of infantile haemangioma (IH) after a first course of treatment with oral propranolol for at least six months (initiated after the marketing authorization had been granted) have not previously been investigated. ObjectivesTo identify factors associated with the risk of early relapse in children with IH treated with oral propranolol according to the current prescribing guidelines. MethodsWe performed a multicentre, retrospective, case-control study, using the Ouest Data Hub database. All children treated for at least 6 months with oral propranolol for IH between 31 June 2014 and 31 December 2021, and with a follow-up visit at least three months after treatment discontinuation were included. A case was defined as relapse of IH within three months of treatment discontinuation; each case was matched for age at treatment initiation and for centre, with four (relapse-free) controls. The association between relapse and treatment or IH characteristics was expressed as an odds ratio (OR) from univariate and multivariate conditional logistic regressions. ResultsA total of 225 children were included. Of these, 36 (16%) relapsed early. In a multivariate analysis, a deep IH component was a risk factor for early relapse [OR = 8.93; 95%CI: 1.0–78.9, p = 0.05]. A propranolol dosage level of less than 3 mg/kg/day protected against early relapse [OR = 0.11; 95%CI: 0.02–0.7, p = 0.02]. Tapering before propranolol discontinuation was not associated with a lower risk of early relapse. ConclusionThe risk factors for late and early relapse are probably different. Investigation of the risk factors for early vs. late IH relapse is now warranted.

Adverse risk factors for salvage radiotherapy outcomes after radical prostatectomy in prostate cancer patients.

To investigate salvage treatment approaches and treatment outcomes in high-risk prostate cancer after radical prostatectomy (RP). In this retrospective, multicenter study, 272 patients who underwent salvage radiotherapy (RT) ± androgen deprivation therapy (ADT) for recurrent prostate cancer after RP between 2007 and 2021 were analysed. Univariate analyses of time to biochemical and clinical relapse after salvage therapies were conducted using Kaplan-Meier plots and log-rank tests. Multivariate analyses were performed using a Cox proportional hazards model to determine the risk factors for disease relapse. Median age was 65 (48-82) years. All patients underwent salvage prostate bed RT. Pelvic lymphatic RT was performed in 66 patients (24.3%) and ADT was included in 158 (58.1%) patients. The median PSA value before RT was 0.35ng/mL. The median follow-up time was 64 (12-180) months. 5-years bRFS, cRFS, and OS were 75.1%, 84.8%, and 94.9% respectively. In multivariate cox regression analysis; seminal vesicle invasion (HR 8.64, 95% CI 3.47-21.48, p < 0.001), pre-RT PSA higher than 0.14ng/mL (HR 3.79, 95% CI 1.47-9.78, p= 0.006), and ≥ 2 positive pelvic lymph nodes (HR 2.50, 95% CI 1.11-5.62, p= 0.027) were found to be unfavorable prognostic factors for bRFS. Salvage RT ± ADT provided 5-years biochemical disease control in 75.1% of patients. Seminal vesicle invasion, ≥ 2 positive pelvic nodes and delayed administration of salvage RT (PSA levels higher than 0.14ng/mL) were found to be adverse risk factors for relapse. Such factors should be taken into account during the decision process on salvage treatment.

Non-Expressed Donor KIR3DL1 Alleles May Represent a Risk Factor for Relapse after T-Replete Haploidentical Hematopoietic Stem Cell Transplantation.

KIR3DL1 alleles are expressed at different levels on the natural killer (NK) cell surface. In particular, the non-expressed KIR3DL1*004 allele appears to be common in Caucasian populations. However, the overall distribution of non-expressed KIR3DL1 alleles and their clinical relevance after T-replete haploidentical hematopoietic stem cell transplantation (hHSCT) with post-transplant cyclophosphamide remain poorly documented in European populations. In a cohort of French blood donors (N = 278), we compared the distribution of expressed and non-expressed KIR3DL1 alleles using next-generation sequencing (NGS) technology combined with multi-color flow cytometry. We confirmed the predominance of the non-expressed KIR3DL1*004 allele. Using allele-specific constructs, the phenotype and function of the uncommon KIR3DL1*019 allotype were characterized using the Jurkat T cell line and NKL transfectants. Although poorly expressed on the NK cell surface, KIR3DL1*019 is retained within NK cells, where it induces missing self-recognition of the Bw4 epitope. Transposing our in vitro observations to a cohort of hHSCT patients (N = 186) led us to observe that non-expressed KIR3DL1 HSC grafts increased the incidence of relapse in patients with myeloid diseases. Non-expressed KIR3DL1 alleles could, therefore, influence the outcome of hHSCT.

Lower pretreatment HBV DNA levels are associated with better off-treatment outcomes after nucleo(s)tide analogue withdrawal in patients with HBeAg-negative chronic hepatitis B: A multicentre cohort study

Background & AimsPretreatment predictors of finite nucleo(s)tide analogue (NUC) therapy remain elusive. We studied the association between pretreatment HBV DNA levels and outcomes after therapy cessation. MethodsPatients with chronic hepatitis B who were HBeAg negative at the start of NUC treatment were enrolled from sites in Asia and Europe. We studied the association between pretreatment HBV DNA levels and (1) clinical relapse (defined as HBV DNA >2,000 IU/ml + alanine aminotransferase >2 × the upper limit of normal or retreatment) and (2) HBsAg loss after NUC withdrawal. ResultsWe enrolled 757 patients, 88% Asian, 57% treated with entecavir, with a median duration of treatment of 159 (IQR 156–262) weeks. Mean pretreatment HBV DNA levels were 5.70 (SD 1.5) log IU/ml and were low (<20,000 IU/ml) in 150 (20%) and high (>20,000 IU/ml) in 607 (80%). The cumulative risk of clinical relapse at 144 weeks after therapy cessation was 22% among patients with pretreatment HBV DNA levels <20,000 IU/ml vs. 60% among patients with pretreatment HBV DNA levels >20,000 IU/ml, whereas the cumulative probabilities of HBsAg loss were 17.5% vs. 5% (p <0.001). In multivariable analysis, pretreatment HBV DNA levels <20,000 IU/ml were independently associated with a reduced likelihood of clinical relapse (adjusted hazard ratio 0.379, p <0.001) and with an increased chance of HBsAg loss (adjusted hazard ratio 2.872, p <0.001). ConclusionsLower pretreatment HBV DNA levels are associated with a lower risk of clinical relapse and a higher chance of HBsAg loss after cessation of NUC therapy, independent of end-of-treatment viral antigen levels. Further studies are needed to confirm these findings in non-Asian populations. Impact and ImplicationsA subgroup of patients with chronic hepatitis B may not require retreatment after stopping antiviral therapy. In this study, comprising 757 patients with chronic hepatitis B from Europe and Asia, we found that higher viral load before initiation of treatment was a risk factor for relapse after stopping treatment. Patients with a low HBV DNA level before starting antiviral therapy had the lowest risk of relapse, and a high chance of HBsAg loss, after stopping treatment. These findings can help select patients for treatment withdrawal and guide intensity of off-treatment monitoring.

Time to Relapse and Relapse Predictors in Patients with Schizophrenia at Ayder Comprehensive Specialized Hospital, Northern Ethiopia

Background. Rehospitalization, treatment resistance, and impairment are all possible outcomes of a schizophrenia relapse, which has a severe impact on patients, families, and the healthcare system. However, little is known regarding the time to relapse and relapse predictors in Ethiopia and in the study settings. Therefore, the aim of this study was to determine the time to relapse and relapse predictors in patients with schizophrenia at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Methods. A retrospective cohort study was carried out among 273 schizophrenia patients discharged from Ayder Comprehensive and Specialty Hospital between January 2015 and January 2019. The data was taken from the patient’s medical record and was chosen using a systematic random sampling procedure. A standardized data collection checklist was employed. The survival experiences of participants were compiled using a life table. Both univariate and multivariate Cox regression models were used for variable selection. Finally, after confirming the model’s diagnosis and assumptions, factors with a p value of less than 0.05 were declared to be statistically significant predictors of schizophrenia relapse. Results. In this study, the incidence of relapse was 2.9 per 100 person-months (PMs) and the median time to relapse of 13 months (interquartile range: 6–23 months). Being divorced ( AHR = 2.50 , 95% CI: 1.18-5.28), not adhering to treatment ( AHR = 5.7 , 95% CI: 3.03-10.74), and substance abuse ( AHR = 1.8 , 95% CI: 1.01-3.22) were risk factors for increasing schizophrenia relapse. Age ( AHR = 0.65 , 95% CI: 0.34-0.88) and length of first hospitalization ( AHR = 0.69 , 95% CI: 0.57-0.86) were factors that decreased schizophrenia relapse. Conclusion and Recommendation. In this study, out of 100 patients with schizophrenia followed up for a month, three had a relapse, and the highest risk factor for relapse was treatment nonadherence, followed by being divorced and substance misuse. As a result, it is advised that all parties involved focus on early detection and taking preventive measures against schizophrenia relapse, as well as providing regular psychoeducation about the significance of treatment adherence and connecting patients with substance misuse to substance rehabilitation centers.

¿Se puede realizar la radioterapia intraoperatoria de forma asistencial en el tratamiento del cáncer de mama en estadios iniciales?

After conservative surgery in breast cancer adjuvant radiation therapy is indicated, such treatment can be performed as partial irradiation in well-selected cases and without risk factors for local relapse following the guidelines of international consensus. Partial irradiation is performed by several techniques such as interstitial brachytherapy, external radiation therapy, and also through intraoperative radiation therapy techniques at the same surgical act due to mobile electron accelerators or low-energy photons units. This allows local treatment to be performed in a single day, increasing the surgical time, but with advantages in terms of the tumor bed localization accuracy, immediacy of irradiation and greater patient satisfaction. There is extensive experience in the use of this technique with results comparable to other ways of partial irradiation in terms of local control, minimal side effects, good cosmetic results and even better no cancer related survival. This article reviews the evidence in the use of intraoperative radiation therapy in early-stage breast cancer derived from the main trials comparing it to whole breast irradiation, to confirm that it is already available for standard of care practice in patients who are candidates for partial irradiation.

Should stressful life events be monitored after a first episode of psychosis?

In the 3 years following a first episode of psychosis, 50% of individuals will experience a relapse, which could be expressed as symptom exacerbation or readmission to a psychiatric inpatient unit. 1 Alvarez-Jimenez M Priede A Hetrick SE et al. Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophr Res. 2012; 139: 116-128 Crossref PubMed Scopus (312) Google Scholar Hence, finding the relevant risk factors for new episodes is an urgent matter in psychiatric research and clinical practice. Whereas risk factors such as substance misuse and non-adherence to medication are well understood and can be targeted by interventions, less is known about other factors that might also be important, such as sleep deprivation, depressive or manic symptoms, or stressful life events. 1 Alvarez-Jimenez M Priede A Hetrick SE et al. Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophr Res. 2012; 139: 116-128 Crossref PubMed Scopus (312) Google Scholar Among these factors, stressful life experiences are associated with an increased risk of developing psychosis in people who are already considered as having a high risk of psychosis. 2 Betz LT Penzel N Kambeitz-Ilankovic L et al. General psychopathology links burden of recent life events and psychotic symptoms in a network approach. NPJ Schizophr. 2020; 6: 40 Crossref PubMed Scopus (20) Google Scholar , 3 Mayo D Corey S Kelly LH et al. The role of trauma and stressful life events among individuals at clinical high risk for psychosis: a review. Front Psychiatry. 2017; 8: 55 Crossref PubMed Scopus (110) Google Scholar Therefore, it could be possible that stressful life experiences also affect the risk of relapses after the first episode of psychosis. Stressful life events and relapse of psychosis: analysis of causal association in a 2-year prospective observational cohort of individuals with first-episode psychosis in the UKThese results provide converging evidence of a causal effect of stressful life events on the risk of relapse in psychosis. They suggest that there is a need to develop interventions at the individual and health-service level that could mitigate the harmful effects of stressful life events. Full-Text PDF Open Access

Giant cell tumour of bone.

Giant cell tumour of bone (GCTB) is a locally aggressive lesion that is difficult to treat as salvaging the joint can be associated with a high rate of local recurrence (LR). We evaluated the risk factors for tumour relapse after treatment of a GCTB of the limbs. A total of 354 consecutive patients with a GCTB underwent joint salvage by curettage and reconstruction with bone graft and/or cement or en bloc resection. Patient, tumour, and treatment factors were analyzed for their impact on LR. Patients treated with denosumab were excluded. There were 53 LRs (15%) at a mean 30.5 months (5 to 116). LR was higher after curettage (18.4%) than after resection (4.6%; p = 0.008). Neither pathological fracture (p = 0.240), Campanacci grade (p = 0.734), soft-tissue extension (p = 0.297), or tumour size (p = 0.872) affected the risk of recurrence. Joint salvage was possible in 74% of patients overall (262/354), and 98% after curettage alone (262/267). Of 49 patients with LR after curettage, 44 (90%) underwent repeated curettage and joint salvage. For patients treated by curettage, only age less than 30 years (p = 0.042) and location in the distal radius (p = 0.043) predicted higher LR. The rate of LR did not differ whether cement or bone graft was used (p = 0.753), but may have been reduced by the use of hydrogen peroxide (p = 0.069). Complications occurred in 15.3% of cases (54/354) and did not differ by treatment. Most patients with a GCTB can undergo successful joint salvage by aggressive curettage, even in the presence of a soft-tissue mass, pathological fracture, or a large lesion, with an 18.4% risk of local recurrence. However, 90% of local relapses after curettage can be treated by repeat joint salvage. Maximizing joint salvage is important to optimize long-term function since most patients with a GCTB are young adults. Younger patients and those with distal radius tumours treated with joint-sparing procedures have a higher rate of local relapse and may require more aggressive treatment and closer follow-up.

Sense of coherence and perception of self-influence on the disease course among patients with schizophrenia including quality of life - pilot studies.

Current research studies reveal many protective and risk factors for relapse among patients with schizophrenia. The main aim of this study was to make an attempt at identifying the relationship between sense of coherence, self-influence on the disease course and quality of life determined by patients' suffering from schizophrenia current state of health. The study involved 50 patients, diagnosed with schizophrenia by the ICD-10 criteria, who were/ were not suffering from relapse in 2-year period from last hospitalization. In order to measure sense of coherence, self-influence on the disease course and quality of life, patients were asked to complete: Sense of Coherence Scale (SOC-29), Brief Measure to Assess Perception of Self-Influence on the Disease Course - Version for Schizophrenia and Sense of the Quality of Life Questionnaire. Statistical analysis revealed no differences in sense of coherence, perception of self-influence on the disease course and quality of life among patient with relapse or during remission. Nevertheless, the relation between sense of coherence and quality of life was observed in both groups. Patients who were suffering from relapse had their metaphysical (spiritual) quality of life also correlated with perception of self-influence on the disease course. This pilot study leads to conclusion that sense of coherence - along with its manageability and meaningfulness components - may be closely related to psychophysical, psychosocial and subjective quality of life for patients suffering from schizophrenia, both in long remission and currently experiencing a relapse.

Post-Surgical Indications to Radioiodine Treatment and Potential Risk Factors for Post-Treatment Recurrence in Patients with Intermediate-Risk Differentiated Thyroid Carcinoma.

In this multicentric retrospective observational study, we investigated the potential risk factors for radioiodine (RAI) indication and the post-treatment recurrence of intermediate-risk differentiated thyroid cancer (DTC) 1 and 3 years from diagnosis. We included 121 patients who underwent thyroidectomy for intermediate-risk DTC. The 92 patients (76.0%) who underwent RAI treatment had a higher prevalence of extra-thyroid micro-extension (mETE) (p = 0.03), pT3 staging (p = 0.03) and recourse to therapeutic central (p = 0.04) and lateral (p = 0.01) neck dissection, as well as higher numbers (p = 0.02) and greater dimensions (p = 0.01) of lymph node metastases, compared with untreated patients. Relapse was observed in 18.1% and 20.7% of cases 1 and 3 years from diagnosis, respectively, with no significant differences between groups. A lower age at diagnosis (p = 0.03) and higher levels of stimulated thyroglobulin (Tg) (p = 0.04) emerged as the only independent risk factors for tumour relapse at 1 year. Tumour relapse at 3 years was only independently predicted by the presence of tumour relapse at 1 year (p = 0.04). In conclusion, mETE, pT3 and the presence of large, multiple or clinically evident lymph node metastases represent the main indicators for referring patients to RAI treatment. Early recurrence may be considered the most relevant factor when planning further surveillance.

Prognostic factors and clinical outcomes in patients with relapsed acute leukemia after allogeneic hematopoietic stem cell transplantation.

Relapse is a significant barrier to allogeneic hematopoietic stem cell transplantation (allo-HSCT) success. To explore the prognosis of patients who underwent relapse after allo-HSCT, we retrospectively examined 740 consecutive acute leukemia patients in our single center transplanted between January 2013 and December 2018, of which 178 relapsed. The median survival was 204 days (95%CI, 160.7-247.3) from relapse, and the 3-year post-relapse overall survival (prOS) rate was 17.8% (95%CI, 12.5-25.3%). Overall complete remission (CR) or CR with incomplete hematologic recovery (CRi) was achieved in 32.1% for the acute myeloid leukemia and 45.3% for acute lymphoblastic leukemia patients after salvage therapy, respectively. Grade III-IV acute graft-versus-host disease (GVHD) after transplantation and >20% bone marrow blasts at relapse were associated with worse prOS, while patients with chronic GVHD after transplantation, relapse later than 1 year after transplantation, and solitary extramedullary disease had better prOS. Therefore, we developed a concise risk scoring system for prOS based on the number of risk factors affecting prOS. This scoring system was validated with another cohort of post-transplant relapsed acute leukemia patients who received allo-HSCT between 2019 and 2020. Identifying relapse risk factors and providing personalized care for patients with poor prognoses is crucial for improving survival.

Stratification of risks of tuberculosis relapses during the pandemic of the novel coronavirus infection

The objective: to assess risk factors for tuberculosis relapse during the COVID-19 pandemic.Results. During the retrospective study, medical documents of patients treated for tuberculosis in 2020-2022 were analyzed. 140 patients above 18 years old with confirmed tuberculosis were included: newly diagnosed tuberculosis – 50 patients, early relapses – 50 patients, and late relapses – 40 patients. At the first stage, significant factors for relapse development were identified (ANOVA): diabetes (F=19402,8; p=0,000000), substances abuse (F=547,6; p=0,000000), alcohol abuse (F=149,7; p=0,000000), MDR MTB (F=107,8; p=0,000000), HIV infection (F=72,4; p=0,000000), imprisonment (F=49,5; p=0,000000), chronic respiratory diseases (F=47,1; p=0,000000), smoking (F=29,0; p=0,000000), and social status (F=28,9; p= 0,000000). At the second stage (cluster analysis), factors implementing the risks of development of early or late relapses were identified.As well as before the COVID-19 pandemic, social, medical and biological risk factors play a significant role in the development of tuberculosis relapses; history of COVID-19 was not one of the risk factors; and stratification of the risk factors made it possible to identify factors that contribute to development of both early and late relapses and to determine preventive measures.

Risk Factors for Relapse and/or Prolonged Glucocorticoid Therapy in Polymyalgia Rheumatica: Multicenter Study in 185 Patients.

In polymyalgia rheumatica (PMR) relapses and long-term GC dependency are common. We assessed risk factors for higher relapse rate and/or prolonged glucocorticoid therapy in PMR patients. A multicenter and observational study (chart review) of PMR patients seen between 2006 and 2021 who had at least a 3-month follow-up period after starting GCs was performed. Results were expressed as median and interquartile range 25th-75th or mean ± standard deviation for numerical variables and percentage for categorical ones. Relapse versus nonrelapse groups were compared using Cox proportional analysis. Hazards ratios (HRs) with 95% confidence intervals (CIs) are reported. In all cases, a p value <0.05 was considered to indicate statistical significance. We included 185 patients (69.1% female). The median follow-up time was 17.1 months (interquartile range, 6.8-34.7). Incidence of relapses was 1.2 per 100 persons/month. In univariate analysis, PMR patients with a previous history of dyslipidemia had a lower risk of relapse (HR, 0.55; 95% CI, 0.33-0.94; p = 0.03); high-dose GC (HR, 2.35; 95% CI, 1.42-3.87; p = 0.001) and faster GC dose reduction had higher risk of relapse (HR, 3.04; 95% CI, 1.77-5.21; p = 0.001). In multivariate analysis, a previous history of dyslipidemia had a lower risk of relapse (HR, 0.54; 95% CI, 0.32-0.92; p = 0.023), and high dose of GC (HR, 2.46; 95% CI, 1.49-4.08; p = 0.001) remained the only risk factors for relapse. Lower doses of corticosteroids and a slow rate of reduction are critical to avoid relapse in PMR. Risk factors for higher relapse rate rely on therapy more than clinical characteristics of the patients at the time of diagnosis of PMR.

Роль когнитивных искажений в поддержании паттерна сексуального насилия

&lt;p style="text-align: justify;"&gt;Distorted judgments supporting commitment of criminal sexual acts are widely used in persons with abnormal sexual behavior and considered by foreign researchers as one of the dynamic risk factors of relapse of sexual crimes against minors. The submitted article is an analytical review of the main foreign research papers on the problem of cognitive distortions in sexual offenders. Various attempts to conceptualize and categorize cognitive distortions are presented with their theoretical and empirical verification, structural characteristics and some features of the development of such distorted judgements. The self-report questionnaires are mainly used in foreign studies of cognitive distortions, also samples of sexual offenders are studied include both persons with sexual disorders and situational offenders. The article shows the necessity of distinguishing between prior and posterior cognitive distortions, as well as self-justification inherent in human nature and distorted judgements that contribute to the commission of criminal acts. It has been suggested that the assessment of cognitive distortions should be carried out not only by unified questionnaires, but using a phenomenological analysis of situational behavior and a retrospective analysis of criminal&amp;rsquo;s beliefs before the latter committed the incriminated act.&lt;/p&gt;

Risk factors associated with relapse after methotrexate dose reduction in patients with rheumatoid arthritis receiving golimumab and methotrexate combination therapy.

To identify risk factors for relapse after methotrexate (MTX) dose reduction in rheumatoid arthritis (RA) patients receiving golimumab (GLM)/MTX combination therapy. Data on RA patients ≥20 years old receiving GLM (50 mg) + MTX for ≥6 months were retrospectively collected. MTX dose reduction was defined as a reduction of ≥12 mg from the total dose within 12 weeks of the maximum dose (≥1 mg/wk average). Relapse was defined as Disease Activity Score in 28 joints using C-reactive protein level (DAS28-CRP) score ≥3.2 or sustained (≥ twice) increase of ≥0.6 from baseline. A total of 304 eligible patients were included. Among the MTX-reduction group (n = 125), 16.8% of patients relapsed. Age, duration from diagnosis to the initiation of GLM, baseline MTX dose, and DAS28-CRP were comparable between relapse and no-relapse groups. The adjusted odds ratio (aOR) of relapse after MTX reduction was 4.37 (95% CI 1.16-16.38, P = 0.03) for prior use of non-steroidal anti-inflammatory drugs (NSAIDs), and the aORs for cardiovascular disease (CVD), gastrointestinal disease and liver disease were 2.36, 2.28, and 3.03, respectively. Compared to the non-reduction group, the MTX-reduction group had a higher proportion of patients with CVD (17.6% vs 7.3%, P = 0.02) and a lower proportion of prior use of biologic disease-modifying antirheumatic drugs (11.2% vs. 24.0%, P = 0.0076). Attention should be given to RA patients with history of CVD, gastrointestinal disease, liver disease, or prior NSAIDs-use when considering MTX dose reduction to ensure benefits outweigh the risks of relapse.

Biomarkers as predicting factors for relapse in polymyalgia rheumatica: the importance of alkaline phosphatase.

Dear Editor, PMR is an inflammatory disease that affects older adults and causes pain and stiffness in the neck, shoulders and girdles. PMR is typically accompanied by the elevation of ESR or CRP [1]. Administration of a low–medium dose of steroid is recommended as initial therapy in the treatment of PMR without GCA [1]. Although clinical response is usually favourable, PMR relapses are frequent and have been reported in up to 67% of patients during the first year of follow-up and up to 49% of patients at 5 years [2]. Previous reports have suggested that the elevation of ESR or CRP [2, 3], and female [3], older [4] or heavier [5] patients might be a risk factor for PMR relapse; however, the characteristics underlying PMR relapse require elucidation. Herein, we assessed clinical and laboratory markers of PMR in cases of relapse. Data derived from the initial visit of all adult patients with PMR registered in the database of our hospital from July 2010 to October 2020 were retrospectively collected and analysed. All patients met Bird’s or 2012 ACR/EULAR criteria for PMR. Patients with a history or coexistence of GCA, patients who were suspected of having PMR initially, then whose diagnosis was changed from PMR to another (such as paraneoplastic syndrome), and patients with insufficient data were excluded. Patients who relapsed at least once were classified as the relapse group. We defined ‘relapse’ as a reappearance of clinical symptoms typically as PMR accompanied by an elevation of ESR (≥30 mm/h) or CRP (≥0.5 mg/dl) during the clinical course based on a previous report [2]. The univariate analysis between the relapse and non-relapse groups was performed using Fisher’s exact test (categorical variables) and Mann–Whitney U test (continuous variables). The cut-off for significant difference in the univariate analysis of new continuous variables was calculated using the following method. (i) The minimum to maximum values were separated by 5 and used as cut-off candidates. (ii) We binarized the candidates to above/below the value and added them to the established factors previously measured (age, sex, body weight, CRP and ESR) [2–5]. We created a logistic regression model using all the abovementioned factors as explanatory variables. (iii) Based on the prediction probability calculated from the model, the receiver operating characteristic (ROC) curve related to relapse/non-relapse was drawn, and the area under the curve (AUC) was calculated. (iv) By repeating these steps, the cut-off value candidate with the largest AUC was defined as the final cut-off value. Subsequently, we performed a multivariate logistic regression analysis. A P-value of <0.05 indicated statistical significance, and the adjusted odds ratio and corresponding 95% CI were subsequently estimated. A total of 72 patients were enrolled (Table 1). In total, 51 (70.8%) patients were women, and 31 (43.1%) had experienced a relapse. The univariate analysis revealed that age, sex and body weight did not show significant differences. ESR and serum alkaline phosphatase (ALP) were significantly higher in the relapse group than in the non-relapse group (96.0 vs 75.0 mm/h, P = 0.008; and 314.0 vs 253.0 U/l, P = 0.006, respectively). Although abdominal ultrasonography was performed in 11/72 (15.3%) cases, none revealed cholestatic liver diseases. Serum ALP was extracted as a new factor with a significant intergroup difference.

Evaluating Efficacy and Safety of Tacrolimus Treatment in Membranous Nephropathy: Results of a Retrospective Study of 182 Patients.

Tacrolimus is recommended by KDIGO Clinical Practice Guidelines as an initial therapy for the treatment of membranous nephropathy (MN). However, little is known about the factors that influence response and recurrence of the disease after tacrolimus therapy, and there are limited data regarding the duration of tacrolimus treatment. Here, we present a real-world retrospective cohort study of 182 MN patients treated with tacrolimus, aiming to assess the efficacy and safety of tacrolimus in the treatment of MN. The clinical data of 182 patients with MN treated with tacrolimus and followed up for at least one year were analyzed retrospectively for the efficacy and safety of tacrolimus. The mean follow-up period was 27.3 (19.3-41.6) months. A total of 154 patients (84.6%) achieved complete or partial remission, and 28 patients (15.4%) did not. Multivariate Cox regression analysis showed that male and higher baseline BMI were independently associated with lower, while higher serum albumin was associated with higher probability of remission. Among the responders, 56 patients (36.4%) relapsed. After adjustments for age and sex, Cox regression analysis revealed that the longer period of full-dose tacrolimus was administered, the lower the incidence of relapse. However, high levels of serum creatinine and proteinuria at the onset of tacrolimus discontinuation were risk factors for relapse. During the treatment of tacrolimus, a decline in renal function (≥50% increase in serum creatinine after the onset of tacrolimus treatment) was the most common adverse reaction, observed in 20 (11.0%) patients, followed by elevated blood glucose and infection, but the latter two occurred mostly during treatment with tacrolimus plus corticosteroids. Tacrolimus is effective in the treatment of MN, but the relapse rate is high. Clinical studies with larger sample sizes are needed to further explore the use of tacrolimus in the treatment of membranous nephropathy.

What are the predominant predictors of seizure relapse following discontinuation of anti-seizure medication in epileptic children?

The aim of the study was to identify the predominant predictors of seizure relapse following discontinuation of ASM in epileptic children. The study cohort consisted of 403 epileptic children who had a withdrawal process of ASM (monotherapy: 344; dual therapy or polytherapy: 59) after at least a 2-year seizure-free period. Patients were categorized if they had a well-defined epileptic syndrome. Epileptic children with ongoing ketogenic diet, vagal nerve stimulation, or surgery were excluded from the cohort due to the additional withdrawal process related to other therapy modalities. The cohort's seizure relapse rate was 12.7% (51/403). The highest rates of seizure relapse were defined for genetic etiology at 25% and structural etiology at 14.9%. An epilepsy syndrome was defined in 183 of 403 children (45.4%). There was no difference in the seizure relapse rate between the subgroups of well-defined epileptic syndromes; 13.8% for self-limited focal epileptic syndromes, 11.7% for developmental and epileptic encephalopathies, and 7.1% for generalized epileptic syndromes. Five predictors were defined as the most powerful predictors of seizure relapse in univariate analysis: age at epilepsy diagnosis >2 years (hazard ratio [HR]: 1.480; 95% confidence interval [CI]: 1.134-1.933), defined etiology (HR: 1.304; 95% CI: 1.003-1.696), focal seizure (HR: 1.499; 95% CI: 1.209-1.859), ≤3 months duration of the withdrawal process (HR: 1.654; 95% CI: 1.322-2.070), and a history of neonatal encephalopathy with or without seizures (HR: 3.140; 95% CI: 2.393-4.122). In multivariate analysis, the main predictor of seizure relapse was a history of neonatal encephalopathy with or without seizures (HR: 2.823; 95% CI: 2.067-3.854). The duration of seizure freedom before discontinuation of ASM was not a predominant risk factor for seizure relapse: 2-3 years versus >3 years. The predictive values of five predictors of seizure relapse rate should be evaluated for patients with different epilepsy subgroups.

Club foot management in the Bafoussam Baptist Healthcare center (BBHC), Cameroon: Treatment outcomes and the associated factors of relapse with the Ponseti’s technique

Background: Clubfoot is a birth defect found in about 1000 live births yearly in Cameroon and its treatment is often associated with relapses. The objective of this study was to evaluate treatment outcomes with the Ponseti’s technique and factors associated with relapses. Methods: We conducted a 5-year retrospective study on clubfoot children at the Bafoussam Baptist Healthcare Center (BBHC). Data on age, sex, birth setting, previous treatment, pirani scoring, number of casts and follow-ups, bracing and relapse were recorded in case report forms. Data were analyzed with SPSS: 25 software; bivariate analysis was performed to determine factors associated with relapse. Results: This study enrolled 78 clubfoot children with median age, 12 months (IQR1,24), 44 (56.4%) had undergone previous treatment elsewhere. The mean Pirani score before treatment was 4.9 [±SD: 0.9] for the left foot (LF), and 4.9 [±SD: 1] for the right (RF). The average number of casts performed was 6.5 [±SD: 1.5]. Tenotomy of the Achilles tendon was performed in 54 (69.2%) children. The mean final Pirani score was 0.9 [±SD: 0.5] for the LF and 0.8 [±SD: 0.6] for the RF. Only 5 (6.4%) cases did not wear Iowa braces and loss of sight rate was 1.3% (1/78). The relapse rate was 9.1% (7 /77). Treatment requiring &gt;8 casts was associated with relapse (aOR: 10.35; CI [1.05-101.55]; P=0.04). Conclusion: The Ponseti’s technique is effective in the treatment of CTEV in the West region of Cameroon. Treatment requiring more than 8 cats is a risk factor for relapse.

Long-Term Pharmacological and Psychosocial Outcomes of Adolescent-Onset Epilepsy: A Single-Center Experience

Purpose: Despite the high incidence of epilepsy during adolescence, little attention has been paid to the outcomes and prognosis of adolescent-onset epilepsy. The aim of this study was to investigate the long-term pharmacological and psychosocial outcomes of adolescent-onset epilepsy.Methods: From 1993 to 2019, the electronic medical records of adolescent-onset epilepsy patients were retrieved from Asan Medical Center Children’s Hospital. Seizure outcomes were evaluated based on the seizure-free period at last contact. Possible predictors of remission, relapse, and intractability were investigated. Neuropsychiatric comorbidities, socioeconomic status, and transition outcomes were also assessed. Results: In total, 137 patients were enrolled in this study. The median age at diagnosis of epilepsy was 14 years and the mean duration of therapy was 13.0 years. During follow-up, 93 patients (67.9%) achieved terminal remission, of which 27 cases (19.7%) resolved. Relapse after withdrawal of medication occurred in 74 patients (54.0%), and the presence of electroencephalographic abnormalities (odds ratio [OR], 8.23; 95% confidence interval [CI], 1.39 to 48.87; P=0.020), poor adherence (OR, 4.84; 95% CI, 2.13 to 11.02; P=0.000), and history of febrile seizures (OR, 4.10; 95% CI, 1.21 to 13.93; P=0.024) were risk factors for relapse. Neurodevelopmental and psychological comorbidities were documented in 17 (12.4%) and 12 (8.8%) patients, respectively. Thirty-six (26.3%) patients transferred to adult clinics, at a mean age of 21.9 years. Conclusion: This study showed overall favorable seizure outcomes with a high rate of remission, but with frequent relapse after withdrawal.